Global risk assessment urged for hypertensive patients

By Eleanor McDermid, Senior medwireNews Reporter

Global risk assessment has a large impact on the risk stratification and therefore management of patients with hypertension, a study shows.

Researcher Chang Gyu Park (Korea University Guro Hospital, Seoul) and colleagues used the risk stratification system from the 2007 European Society of Hypertension (ESH) guidelines to assess the cardiovascular risk of 3109 hypertensive patients treated by 247 primary care physicians in 230 clinics.

This required the patients to provide blood and urine samples for additional testing for cardiometabolic risk factors and target-organ damage. Tests included blood glucose and glycated haemoglobin, lipid profiles, creatinine and urine microalbumin.

The team found that “the risk evaluation by primary care physicians was substantially changed as a result of additional simple tests.” They therefore advise that “comprehensive cardiovascular risk stratification should be undertaken in all hypertensive patients.”

Based on medical records and clinical impression, the physicians had classified 42%, 44% and 14% of the patients as low, moderate and high risk, respectively. But after the results of the additional tests and application of the ESH risk stratification scheme these proportions changed to 13%, 27% and 60%, respectively.

In the low- and moderate-risk groups, just 19.9% and 24.8% of patients, respectively, remained in the same group, whereas 81.9% of high-risk patients retained their classification.

“Accordingly, the benefit of risk evaluation and stratification was greatest in the moderate-risk group”, the team writes in Hypertension Research.

Also, reclassification based on the discovery of diabetes and/or chronic kidney disease resulted in many of the patients receiving new, more stringent blood pressure targets, meaning that the proportion considered to have controlled blood pressure fell from 82.2% to 65.3%. Again, the changes were predominantly in the former low- and moderate-risk groups.

Of note, applying the risk stratification scheme to body mass index had the opposite effect on risk classification, with obese patients often reclassified to a lower-risk group when found to have no other risk factors or target-organ damage.

“This result also implies that physicians tend to estimate the risk of hypertensive patients based on an impression, which leads to a substantial gap between the ‘perceived risk’ and the ‘actual cardiometabolic risk’ of the patients”, say Park et al.

Combination antihypertensive treatment was overused in the low-risk group relative to the other groups when stratified with the ESH tool, but not when stratified by the physicians. This shows that the difference was caused by incomplete risk assessment, rather than by undertreatment on the part of the physicians, says the team.

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